Healthcare Provider Details

I. General information

NPI: 1821014705
Provider Name (Legal Business Name): JEFFREY FISHBERGER M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE ST. LUKE'S ROOSEVELT HOSPITAL CENTER, SUITE 2T
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

PO BOX 95000-2240
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-6500
  • Fax: 212-523-7182
Mailing address:
  • Phone: 212-523-6500
  • Fax: 212-523-7182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number187421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: